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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
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1.
AKA: ____________________ gland
2.
Location: ________________________
3.
Composed of the Adrenal ____________ & the Adrenal ______
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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
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1.
___________ cardiac output
2.
___________ metabolic rate
3.
Vaso_____________________
4.
___________ respiratory rate
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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:
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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 ____________________
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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.
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Weight _________________
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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.
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Plasma ________________level
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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
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1.
High in ________________
2.
High ________________
3.
Low___________________ & _________________
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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???
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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
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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
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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. ______________________
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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
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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
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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
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1.
Monitor ___________
2.
___________________
3.
____________ levels
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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
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 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)
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13. Know the nursing management for a patient undergoing the following procedures:
 Thyroidectomy
 Adrenalectomy
14. Know your vocabulary words
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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
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