Download Endocrine Day -4 - Porterville College Home

Endocrine handout #4
I.
Reading assignment: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 11th ed.
A. Chapter 42, Pages 1439-1448
II.
III.
Student Learning Outcomes
A. The student will be able to describe etiology, pathophysiology, clinical manifestations,
nursing management and patient education for the following
1.Hypopituitarism
2.Diabetes insipidus
3.Acromegaly
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
Hypothalamus
A. Description
1.Attached to _____________________ by the _________________
B. Location
1.___________________________
2.___________________________
C. Function
1.Stimulate the ______________________ to secrete its _______________
IV.
Pituitary
A. Description
1.“___________________” gland
a. _______ # hormones
b. Size _________________________
c. _____________________ lobe
1) Adenohypophysis
2) ___________ # hormones
d. _____________________ lobe
1) Neurohypophysis
2) ___________ # hormones
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V.
Anterior Pituitary Hormones
Hormone
Function/Action
Stimulated by
Thyroid-stimulating hormone
(TSH)
Stimulate thyroid ___________
_____________________
Stimulate secretion of _______________
________ T3/T4
______ metabolism
______ temperatures
________________
Adrenocorticotropic hormone Stimulate adrenal cortex ____________
(ACTH)
Stimulate secretion of _______________
_____________________
_____________
_________ glycemia
______ glucocorticoids
Follicle-stimulation hormone
(FSH)
Female:
______________________
________________ production
Stimulate _________________ to mature
Male:
Stimulate ____________ production
Luteinizing Hormone (LH)
______________________
Female:
Stimulates __________________
Male:
Stimulate testes to produce ____________
Melanocyte-stimulation
hormone (MSH)
Increase ___________________
Growth hormone (GH) /
Somatotropin
Stimulate __________________
____________________
Stimulate ______________ synthesis
____ growth hormone
______ serum glucose levels
______________
Insulin - _____________________
______________
______glycemia
Prolactin/ Lactogenic
hormone
Stimulates ____________ development
during pregnancy
Stimulates _______________ secretion
after delivery
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VI.
Posterior Pituitary Hormones
Hormone
Function/Action
Stimulated by:
Vasopressin/
Antidiuretic hormone (ADH)
Stimulates water ________________ 
____ serum osmolality
_________ urine output
____ BP
_________ H20 in _______________
Stress
__________
Exercise
Oxytocin
Stimulate uterine ____________________
Breast to ____________________ milk
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VII.
Small Group Questions
A. Which hormone (s)…..
1. Are gonadotropins?
2. Causes increase synthesis of melanin?
3. Causes ovulation?
4. Causes water retention?
5. In high levels causes increased blood pressure?
6. Increases protein synthesis?
7. Increases the metabolism of fatty acids for energy?
8. Is also called Vasopressin?
9. Is also known as somatotropin?
10. Is an insulin antagonist?
11. Is secreted in response to cold temperatures and stress?
12. Is secreted in response to decreased blood pressure, stress, pain, and exercise?
13. Is secreted in response to decreased Somatotropin?
14. Is secreted in response to hypoglycemia, stress, exercise and increased amino
acids?
15. Is secreted in response to increase plasma osmolality?
16. Is secreted in response to stress, hypoglycemia and decreased glucocorticoids?
17. Stimulate ovaries to mature and produce estrogen?
18. Stimulated sperm production?
19. Stimulates adrenal cortex growth?
20. Stimulates breast development?
21. Stimulates testes to produce testosterone?
22. Stimulates the secretion of glucocorticoids?
23. Stimulates the secretion of the thyroid hormone?
24. Stimulates thyroid growth?
25. Stimulates uterine contraction?
VIII.
Hyperpituitarism
A. Definition: _________________ secretion of pituitary hormones
1.Etiology: _________________
a. Usually ____________ & _________________ hormones
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IX.
Growth Hormone Excess
A. Affects
1.Depends on __________________
2.Epiphyses open (young)  ________________________________
B. Gigantism
1.Definition
a. __________ GH before ______________ closes
2.Etiology
a. __________________ of anterior pituitary
1) ____________ in the # of cells  __________________
3.Clinical Manifestations
a. Onset
1) _______________________________
b. > ___________ feet
c. _____________________ overall growth
d. Do not have the ________________________ that size implies
4.Medical Treatment
a. ___________________ of anterior pituitary
b. ___________________ of anterior pituitary via surgery
5.Pharmacology
a. If pituitary is destroyed or removed  ____________________________
6.High risk for
a. _______________ failure
b. __________ tension
c. Thickened _________________
d. __________________________
e. Delayed _________________ development
7.Nursing interventions
a. __________________________
b. ___________________ charts
c. _______________ beds
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C. Acromegaly
1.Definition
a. __________ GH after the epiphyses have _________________
2.Etiology
a. __________-______________ yrs
b. Hyperplasia
c. _________________
3.Clinical manifestations
a. Onset _____________________
b. _________________ = increased in volume d/t _________________ of
existing cells
c.
“___________________” appearance
1) Enlarged _________________
2) Thick _____________________
d.
“_______________” fingers
1) Thick fingers with tips like ______________________
e. _________________, _______________, ____________ handshake
f. Heart, liver, spleen _______________________
g. _____________________
h. _______________, ________________ skin
i. __________________ hypertrophy  ________________________
j. _______________ intolerance
k. Weight ____________
l. ___________ pain
m. Hirsutism
1) _____________________
n. ___________ Libido
1) ____________________
2) Oligomenorrhea
3) Infertility
4.Diagnosis
a. History, S&S, x-ray, CT-scan
b. Lab: _____________________
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5.Prognosis
a. ______ life span
b. DM
1) ____ GH 
2)  ________________ levels 
3) ________ insulin 
4) Stress pancreas 
5) DM type __________
6.Medical treatment
a. Radiation,
b. Surgery
1) Transphenoid hypophysectomy
i. __________ packing
1. Check for ___________________
ii. S&S of __________________
iii. _____________ rigidity
iv. ____________ control
v. NO
1. ____________________
2. ____________________
3. ____________________
4. ____________________
vi. _______________ spirometer
vii. No __________________ x 2 wks
viii. No __________________ x 3 months
c. Medications
1) Bromocriptine mesylate (Parlodel)
i. Action
1. ___________ GH
ii. Nursing Considerations
1. Give with _____________
iii. Side effects
1. ___________________
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2. Stimulates __________________ 
7.Nursing intervention
a. Hx, S&S
b. Monitor __________________ levels
c. ____________ changes
d. Vital signs
e. Jaw changes  _______________________
X.
Small group questions
A. Mrs. Grandios has been diagnoses with acromegaly.
1.What hormonal disturbance causes acromegaly?
2.What signs and symptoms might you expect to see Mrs. Grandios exhibit?
3.What two diagnostic tests might have been performed to diagnosis Mrs.
Grandios?
4.What medical treatment do you expect to be implemented with Mrs. Grandios?
5.What complications might you assess or monitor for with Mrs. Grandios? And
how would you assess for this?
6.Mrs. Grand was prescribed Parlodel. What would you tell her about this
medication?
B. What 2 hormones are affected by hyperpituitarism?
C. Increased GH in adults is diagnosed as what?
D. Increased GH in children is diagnosed as what?
E. What would be your priority nursing diagnosis in a patient diagnosed with acromegaly?
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F. Syndrome of Inappropriate Antidiuretic Hormone (AKA __________________)
G. Definition
1.___________ ADH
2.What does ADS do?
a. Kidneys to _________________ water 
b. __________ urine output 
c. __________ fluid (serum)volume
H. Etiology
1.#1 _________________________
2.Other ______________
3.____________________
I. Clinical manifestations
1.Water _______________
a. ________________
b. Weight ________________
2.Urine
a. ____________________________
b. specific gravity of urine ________________
c. Caused by excess
3.____________ natremia
a. _________________
b. Normal __________ - ___________
c. _______________ cramps
d. ____________________
4.Serum osmolality ____________________
a. Blood leaks into the ___________________ 
b. _____________ swelling 
c. __________________, ___________________, coma 
d. __________________________
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5.Medical treatment
a. Treat ____________________ disorder
b. Resolve fluid volume __________________
1) ________________ H20
2) Promote ____________________________
c. _________________ replacement
6.Pharmacology
a. Furosemide (Lasix)
1) Action
2) Nursing considerations
i. Check __________________________
ii. _____&______
iii. VS
iv. _________________
3) S/E
b. Demeclcycline hydrochloride (Declomycin)
1) Action: Enhances ______________ _______________
c. Fludrocortisone (Florinef)
1) Action: Enhances ______________ retention
2) Nursing considerations
i. Fluid ____________________
7.Nursing diagnosis
a. _____________________________________
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XI.
Hypopituitarism
A. Definition
1.__________________ secretion of pituitary hormones
B. Etiology
1.#1 __________________
2.Congenital defects
3.Pituitary ________________
4.Pituitary ________________
5.Pituitary ________________
C. Signs and symptoms
1.Clinical manifestations are slow to appear and are not really apparent until
____________ of the pituitary is destroyed.
D. Pathophyiology
1.Primary hypopituitarism
a. Trouble with the _________________  ____pituitary hormone secretion
2.Secondary hypopituitarism
a. Trouble ___________________  _____ pituitary hormone secrestion
b. Usually ____________________
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XII.
Hypopituitarism: Growth Hormone
A. Diagnosis
1.___________________
B. S&S (_______ GH)
1.Apparent by ____________ months
2.Delayed _____________________
3.Growth rate _____________ unto ________ feet
4.Body proportion = ______________________
5.Accelerated _________________
XIII.
Hypopituitarism: FSH & LH
A. Female (_____ FSH & LH)
1._____________________________
2._____________________________
3.Decreased _____________________
4._________ atrophy
B. Male (________ FSH & LH)
1.______________________________
2.______________________________
3.Decreased _____________________
4.Testicles _______________________ & ________________________
XIV. Hypopituitarism: TSH
A. Severe ________________ retardation
B. S&S (_________ TSH)
1.Think _________________________
2.______________________________
3.____________ cardia
4.Slow _________________________
5.______________ intolerance
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XV.
Hypopituitarism: ACTH
A. ACTH = handle ___________________
B. S&S (_______ ACTH)
1._______________
2.Weight _____________________
3.___________________________
4.Depigmentation of the ___________________
5.V/S with stress
a. _______ temperature
b. _______ tension
XVI. Hypopituitarism: Prolactin
A. S&S (_______ Prolactin)
1.Absent postpartum ____________________________
XVII. Hypopituitarism: Simmond’s Disease
A. AKA:
1.Panhypopitutarism
B. Definitions
1.Total _________________ of ________________ pituitary hormones
C. Etiology
1.________________
2.________________
3.Injury
4.Tumor
D. Clinical manifestations
1.Weight __________________
2.General _________________
3.Weak
4.______ libido
5.______ intolerance
E. Treatment
1.___________________________________________________________
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XVIII. Hypopituitarism: ADH
A. Diagnosis
1.Diabetes ______________________
B. Definition
1.___________ ____________________
C. Etiology
1.Injury to the ________________________ or _________________
2._______________________
3._______________________
a. Lithium
b. Lasix
4._____________________ not respond to ADH
D. Clinical Manifestions
1.____________________
a. Specific gravity of urine _______________
b. Serum osmolality ____________________
c. Serum Na+ levels ___________________
1) ______________________
2) ______________________
2.Extreme _______________________
a. _____________
3.Weight ______________________
4.Dizziness
5._____________________________
6.Fatigue
E. Complications
1.____________volemia
2.Circulatory ______________________
3.Unconsciouness
4.CNS ___________________
F. Prognosis
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G. Medical treatment
1.Fluid _________________________________
2.Replace _________________________
3.Fix _________________ cause
H. Pharmacology
1.Desmopressin acetate (Stimate)
a. Action:
b. Route:
c. Nursing Action:
2.Vasopressin (Pitressin)
a. Action
b. Route
c. S/E
3.If DI is due to kidney failure
a. ______________________ will not help
b. ________________________________
I. Nursing diagnosis
1.__________________________
J. Nursing interventions
1.______________________
2._________ Na+ intake
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XIX. Small Group Questions
A. Mrs. Waterfall has been diagnosed with lung cancer. She has been complaining of
swelling and weight gain, she thinks it is due to the radiation treatment. The
doctors check her blood values and note an elevated ADH level.
1.What would the name of this disorder be?
2.What is causing the elevated ADH levels?
3.What other lab values would coincide with this disorder?
4.What nursing diagnosis is appropriate for this disorder?
5.What interventions would you as a nurse start with this diagnosis?
6.What medications would you expect the doctor to order?
B. Ms. Pealot is having severe symptoms of polyuria and polydipsia. She goes to the
doctor afraid she has diabetes Mellitus, but is surprised when she is diagnosed with
diabetes Insipidus.
1.Why is Ms. Pealot not started on insulin?
2.What hormonal irregularity causes diabetes Insipidus?
3.What can cause diabetes Insipidus?
4.Besides polyuria and polydipsia, what other clinical manifestation would you
expect her to have?
5.What diagnostic tests would confirm the diagnosis of diabetes Insipidus?
6.What nursing diagnosis would best apply to Ms. Pealot?
7.What nursing interventions would you implement
8.What doctor’s order would you expect to see?
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XX.
Pituitary Tumors
A. Definition
1.___________________
B. Clinical manifestation
1._________________ problems
2.__________________ changes
3.____________________
4.S&S of _____________________________
C. Medical treatment
1.________________ tumor
2.Radiation
3.Cryohypophysectomy
D. Pharmacology
1.__________________________________
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XXI. Study Guide for Quiz #4
A. What are the hormones of the anterior pituitary?
B. What are the hormones of the posterior pituitary?
C. What is the function of each of the pituitary hormones?
D. What is gigantism? What causes it? What are the risk factors for those with gigantism?
What are the nursing considerations for gigantism?
E. What is Acromegaly? What causes it? What are the risk factors for those with
gigantism? What are the nursing considerations for Acromegaly?
F. What is SIADH? What causes it? What are the risk factors for those with SIADH? What
are the nursing considerations for SIADH?
G. What is Diabetes Insipidus? What causes it? What are the risk factors for those with
Diabetes Insipidus? What are the nursing considerations for Diabetes Insipidus?
H. What is transsphenoid hypophysectomy? What are the pre and post op nursing
considerations?
I. Understand the anatomy, location and function of the pituitary
J. What is SIADH? What causes it? What are the clinical manifestations? How is it
treated? What nursing diagnosis and interventions are priorities in SIADH?
K. What is Diabetes Insipidus? What causes it? What are the clinical manifestations? How
is it treated? What nursing diagnosis and interventions are priorities in DI?
L. Know the purpose, and nursing considerations for the following medications:
1.Parlodel
4.Florinef
2.Lasix
5.Stimate
3.Declomysin
6.Pitressin
M. Know the following terms:
1.Hyperpituitarism
5.Hulking
2.Hyperplasia
6.Tuft
3.Epiphseal
7.Hirsutism
4.Hypertrophy
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