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1 Endocrine Handout 6 I. Reading Assignment: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 11th A. Chapter 42, Pages 1473 - 1487 II. Student Learning Outcomes A. The student will be able to describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following 1. Cushing’s syndrome 2. Hyperaldosteronism 3. Pheochromcytoma 4. Addison’s disease B. The student will be able to discuss medical terms commonly used in the endocrine system C. The student will be able to review and identify anatomy and physiology of the endocrine system D. The student will be able to identify components of a complete endocrine physical assessment E. The student will be able to discuss nursing management and patient education in the pre and post operative care of patients undergoing the following surgeries 1. Adrenalectomy III. Adrenal Gland A. Description Endocrine Handout 6 7/29/2009 1. AKA: ____________________ gland 2. Location: ________________________ 3. Composed of the Adrenal ____________ & the Adrenal ______ 2 B. Hormones & Functions Hormone Function Adrenal Cortex Mineralocorticoids Regulates ____________ and fluid (Aldosterone) ____________ Glucocorticoids (Cortisol, Stimulates gluconeogenesis & ↑ blood _______ hydrocortisone) Anti- ___________________ Anti - ___________________ Anti- ___________________ Sex hormones (Androgen) Females: _________________________ Males: ___________________________ Adrenal Medulla Epinephrine (Adrenaline) Prolongs & intensifies ____________ nervous system response to __________________ Norepinephrine Prolongs & intensifies ____________ nervous system response to __________________ C. Effects of Epinephrine & Norepinephrine Endocrine Handout 6 7/29/2009 1. ___________ cardiac output 2. ___________ metabolic rate 3. Vaso_____________________ 4. ___________ respiratory rate 3 D. The cortex synthesizes and secrets more than 30 different steroids. They are divided into 3 main categories 1. Glucocorticoids 2. Mineralocorticoids 3. Androgens E. Learning Tip: 1. An easy way to remember the hormones of the adrenal cortex is to remember “Sugar, Sex & Salt.” a. Cortisol / GLucocorticoids affects sugar (carbohydrate metabolism) b. Androgens are sex hormones c. Aldosterone promotes salt retention F. Negative feedback loop: Endocrine Handout 6 7/29/2009 1. Stress 2. __________________________ (sensor) 3. Stimulates the ________________ pituitary 4. Secretes ___________________ bloodstream target cell 5. ______________________________ 6. Secretes _______________________ target cells 7. _____________________ metabolic activity 8. Helps to manage ____________________ 4 II. Cushing disease/syndrome A. Description: 1. Cortisol _________________ B. Pathophysiology 1. Normal diurnal rhythm 2. Normal secretion of Cortisol is increased during times of ______________ 3. In Cushing's, Cortisol is:_______________________________ without regard to _____________ or ___________________ of day. C. Etiology 1. _________ secretion of ACTH 2. Pituitary _____________ 3. Lung tumor or CA 4. ***#1 Prolonged use of __________________________ meds for inflammatory disorders a. ______________________arthritis b. ____________________________ c. Iatrogenic d. Caused by ____________________ or ________________ procedure 5. Females ________ Males D. Signs and symptoms 1. _______________________________ a. Deposits of ___________________ tissue in the face, neck & trunk b. _______________ shaped face c. __________________ hump 2. Endocrine Handout 6 7/29/2009 Weight _________________ 5 3. Na+ & H2O _________________________ 4. K+ _________________ (_____________________________) 5. ___________________ striae on the abdomen 6. Hirsutism: ______________________________ 7. Thin extremities due to muscle wasting 8. Boys have early onset of puberty 9. Girls exhibit development of masculine characteristics 10. C/O fatigue; muscle weakness, sleep disturbance, water retention, amenorrhea, decrease libido, irritability emotional lability 11. Could have: a. Petechiae b. Ecchymosis c. Decreased wound healing d. Swollen ankles E. Complications 1. Increase _____________reabsorption from the bone leading to ________________________& pathologic fractures 2. Cortisol causes ________________________and 3. Increases hepatic gluconeogenesis and insulin_________________ 4. Leads to glucose intolerance and ___________________________ 5. Frequent ________________ and slow wound ___________ a. Suppressed inflammatory response can mask severe infections b. Cortisol has immunosuppressive action 6. Decreased ability to handle ______________________ a. ______________ problems i.e. mood swings F. Diagnosis 1. Endocrine Handout 6 7/29/2009 Plasma ________________level 6 2. _____________levels 3. Adrenalangiography G. Medical management 1. Early _______________________ key 2. Goal #1 = __________________ hormonal balance 3. Usually accomplished by _______________ 4. Treatment is based on the causative factor 5. If cause is adrenal cancer: _____________________________ 6. If cause of Cushing syndrome is administration of steroid mediation: a. _________________ regiment b. Risk to __________________ analysis H. Surgical management 1. If cause is related to the pituitary gland: ___________________ 2. If cause is adrenal tumor _______________________ I. Pharmacological management 1. Aminoglutethimide (Cytadren) a. Action: ____________________________ of adrenal steroids b. S/E: _____________________________________________ c. Nrs: Instruct to avoid activities that need ________________ 2. Ketoconazole (Nizoral) a. Classification: ___________________ b. Action Inhibits ____________________ steroidogenesis J. Diet Endocrine Handout 6 7/29/2009 1. High in ________________ 2. High ________________ 3. Low___________________ & _________________ 7 K. Nursing management 1. ____________ history 2. V/S 3. __________________ auscultation (________________) 4. ________________________ 5. Skin integrity 6. __________________ levels 7. S&S of _______________________ L. Adrenalectomy 1. Pre-op a. _________________ imbalance b. ___________ glycemia c. Prevent adrenal __________________ 1) Administer _____________________ 2) Sudden ____________________ in hormones crisis 2. Post-op a. _____________ & electrolyte changes b. Replace glucocorticoids, minerocorticoids for ___________ c. Bilateral??? Endocrine Handout 6 7/29/2009 8 III. Addison’s disease A. Description 1. _____________ corticol 2. AKA: Adrenal hypofunction or Adrenal insufficiency or Adrenocortical insufficiency (AI) B. Pathophysiology 1. Occurs when more than ________of the adrenal gland is destroyed 2. ___________-immune disease 3. Primary disease a. ACTH levels may be _________________ 4. Secondary disease a. ACTH levels will be _________________ C. Etiology 1. Primary: a. ________________ adrenalectomy 2. Secondary: a. _______ ACTH from the _______________ b. _________________________ stiumulation 3. Prolonged use of corticosteroid Meds a. _____ ACTH from pituitary b. ______ hormone released from adrenal gland c. ***especially at risk if the drug is abruptly _______________ 1) ______________ dose D. Signs & Symptoms 1. ______________ tension a. D/T lack of _________________ b. ________________ loss Endocrine Handout 6 7/29/2009 9 c. __________________ reabsorption 2. ________________ cardia 3. Orthostatic __________________________ 4. *_____________ coloration of the skin resembling a deep suntan, especially in the creases of the hands, elbows and knees 5. _____________ glycemia 6. Vitiglio 7. __________________ & muscle weakness 8. Weight _______________ 9. Craving ______________ foods 10. ↓tolerance for ____________ a. _______________ b. Irritable c. Confused 11. Pulse _______ 12. G/I upset a. ______________ b. Anorexia E. Complications 1. Adrenal crisis: ________________ Addison’s disease 2. May occur a. Trauma b. _______________ c. Stress d. Abrupt _________________ of cortisone medications 3. Clinical manifestations a. _______ & _________ loss b. _________ tension Endocrine Handout 6 7/29/2009 10 c. ____________________ d. ____________ cardia 4. Treatment a. _______________ b. Administer ____________________ F. Medical management 1. Goal 1 - Restore ____________ and ________________ balance 2. Goal 2 Replacement of ______________________ hormones a. Glucocorticoids (hydrocortisone) b. Mineralocorticoids (Fludrocortisone) G. Pharmacological 1. Lifetime maintenance of steroids 2. Glucocorticoids a. i.e. Hydrocortisone (hydrocortone) 3. Mineralocorticoids a. i.e. fludrocortisone acetate (Florinef) 4. Diurnal rhythm a. ___________ AM b. ___________ PM H. Diet 1. High _____________________________ 2. Low _____________________________ I. Nursing Management 1. Fluid volume ______________ related to low sodium level, vomiting, diarrhea and increased renal losses AMB, poor skin turgor, wt loss, orthostatic hypotension, etc. a. ______________________ b. ______________________ Endocrine Handout 6 7/29/2009 11 c. ______________________ d. ______________________ e. Skin __________________ f. Orthostatic hypotension IV. Comparison of Adrenal Cortex hormone Imbalances Hypofunction Hyperfunction Disorder Signs and symptoms Usual treatment Priority Nursing Diagnoses V. Pheochromocytoma A. Description 1. AKA: Chromaffin cell tumor 2. ________________ disease 3. Characterized by paroxysmal (sustained ) __________________ 4. D/T ____________ secretion of ______________ & ________________________ B. Pathophysiology Endocrine Handout 6 7/29/2009 12 1. Caused by a __________________________ (usually the right adrenal) C. Etiology: ____________________ 1. ________can bring on an attack D. Signs & Symptoms 1. ________________ a. > _____________ mmHg diastolic b. _____________ c. Unstable 2. ___________ cardia 3. Unrelenting _______________ 4. Profuse _________________ 5. Palpitations 6. Visual _______________ 7. Nausea and Vomiting 8. Feeling of ___________________ 9. Elevated blood _____________ level E. Complications 1. _________________ 2. Retinopathy 3. ____________ disease 4. ____________ damage F. Medical management / Surgical 1. Treatment of choice is ______________________________ 2. _____________ before surgery 3. _______________ gland removed 4. BP G. Pharmacological Endocrine Handout 6 7/29/2009 13 1. Phentolamine mesylate (Regitine) a. alpha-adrenergic blocking agent 2. Nitroprusside sodium (Nipride / Nitropress) a. Drug of choice during hypertensive attacks H. Diet 1. High ___________ with adequate calories 2. Avoid _________________ I. Nursing management Endocrine Handout 6 7/29/2009 1. Monitor ___________ 2. ___________________ 3. ____________ levels 14 Study guide for Endocrine final examination 1. Know which gland secretes the following hormones. (See list below) 2. Know what the function is for each of the following hormones. (See list below) 3. Know what the name of the disorder is, if there is an increase or decrease secretion, of the following hormones (and any risk factors that might lead to the order): (See list below) 4. Know the signs and symptoms of an increased or decrease secretion of the following hormones (See list below) 5. Know the complications of an increased or decreased secretion of the following hormones (See list below) 6. Know the medical treatment for an increase or decrease secretion of the following hormones. (See list below) 7. Know the nursing management for an increase or decrease secretion of the following hormones. (See list below) 8. Know the dietary needs for an increase or decrease secretion of the following hormones. (See list below) *Insulin Glucagon Somatostatin *TSH *ACTH FSH LH MSH *GH Prolactin *ADH Oxytocin *T3 & T4 *PTH *Mineralocorticoids *Glucocorticoids Androgen 9. Know the action and nursing consideration for the following medications (including side effects): Insulin Diabaneses Glucatrol Micronase Endocrine Handout 6 7/29/2009 15 Glucophage Glucagon Propranolol Parlodel Lasix Declomycin Florinef Stimate Vasopressin Propylthioracil Tapasole Inderal Radioactive iodine Synthroid / Levothroid Pamidronate Calcium gluconate Cytadren Nizoral Cortisone Regitine Nipride, nitropress 10. Know the onset, peak and duration for the following: Lispro (Humalog); Aspart (Novolog) Humalog R; Novolin R; Iletin II Regular Humulin N; Novolin L; Novolin N NPH Lente Ultralente (UL) 11. Know the correct procedure for drawing up and administering insulin 12. Know the normal levels for the following lab values & nursing considerations Glucose tolerance test Blood glucose/FBS 2h-PPG Serum pH Hgb A1C Sodium Potasium BUN (just what elevated and decreased levels indicate) Serum Osmolarity (just what elevated and decreased levels indicate & what dx) Specific Gravity of urine (just what elevated and decreased levels indicate & what dx) Endocrine Handout 6 7/29/2009 16 13. Know the nursing management for a patient undergoing the following procedures: Thyroidectomy Adrenalectomy 14. Know your vocabulary words Endocrine Handout 6 7/29/2009 17 Hormone Review Match the disorder in column one to a hormone imbalance in column two and the matching signs and symptoms in column three. Disorder Hormone Problem Signs & Symptoms 1. Diabetes Insipidus 1. High T3/T4 1. Short stature 2. SIADH 2. GH deficiency 2. Hulking appearance 3. Cushing’s syndrome 3. High calcium 3. Moon face 4. Addison’s disease 4. ADH excess 4. Labile hypertension 5. Grave’s disease 5. Steroid excess 5. Tetany 6. Hypothyroidism 6. Deficient steroids 6. Muscle weakness 7. Pheochromocytoma 7. Epinephrine excess 7. Polyuria 8. Hyperparathyroidism 8. GH excess 8. Water retention 9. Dwarfism 9. Low T3/T4 9. Weight gain 10. Acromegaly 10. Low calcium 10. Exophthalmos 11. Hypoparathyroidism 11. ADH deficiency 11. Hypotension Endocrine Handout 6 7/29/2009