Download NURS 2016

NURS 2016
Caring for Individuals Experiencing
Endocrine Disorders
Endocrine glands secrete chemical substances called hormones. The release of hormones
from endocrine glands is regulated via a negative feedback system.
The major hormone secreting glands are: hypothalamus, pineal, pituitary, thyroid,
parathyroid, thymus, adrenal, islets of langerhorn, and ovaries/testes.
Thyroid Gland
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
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Produces thyroxin (T4), triiodothyronine (T3), and calcitonin.
Needs iodine for hormone synthesis (iodide taken up in diet then converted to
iodine in the thyroid).
Release of thyroid hormones (T3 & T4 is controlled by Thyroid Stimulating
Hormone (THS) secreted by the pituitary.
T3 & T4 control the rate of cellular metabolism.
Calcitonin reduces elevated serum calcium levels by causing serum calcium to be
deposited in bone.
Laboratory Tests
Thyroid Stimulating Hormone (TSH)
Normal: 0.6-5.2mu/L
 Elevated levels indicate hypothyroidism
 Low levels indicate hyperthyroidism
Cretinism: abnormal fetal growth and development due to untreated prenatal
hypothyroidism.
Goiter: enlarged thyroid gland due to over secretion of thyroid hormones. Commonly
seen with iodine deficiency.
Hypothyroidism: affects approximately 5x as many women as men. Most common is
30-60 age group.
Clinical Manifestations: due to decreased metabolism, which results in a
decreased demand for oxygen, which inturn leads to a decrease in circulation.
Decreased pulse
Decreased temperature
Extreme fatigue
Hair loss
Brittle nails
Dry skin
Numbness/tingling in fingers Menstrual disturbances
Weight gain
Skin becomes thick
Mask-like face
Mental processes subdued
Slowed speech
Thyroid Replacement therapy: goal is to restore normal metabolic state.
Trade name: Eltroxin
Generic name: levothyroxine sodium
Therapeutic Action Increase the metabolic rate of body tissues thereby increasing
oxygen consumption; respiration and heart rate; rate of fat, protein,
and carbohydrate metabolism; and growth and maturation.
Indications
 Replacement therapy for hypothyroidism
 Pituitary TSH suppression
 Treatment of myxedema coma
Contraindications
 Allergy to active or extraneous constituents of the drug
 Acute MI, uncomplicated by hypothyroidism
 Caution with Addison’s and lactation
Adverse effects
 Allergic skin reaction
 Symptoms of hyperthyroidism
Nursing
Assessment
Consideration
 Allergies, acute MI, Addison’s disease, lactation.
 Skin lesions, colour, temperature, texture
 Muscle tone
 Orientation, reflexes,
 Temperature, respirations, pulse
Interventions
 Monitor response carefully, therapeutic effect is not
immediate
 Do not add IV doses to other IV fluids
 Administer oral drug as single dose in am.
 Regular thyroid function test
Monitor cardiac response
List 4 patient teaching opportunities related to Eltroxin
1.
2.
3.
4.
Nursing Considerations: for each of the following Nursing Diagnoses ‘stems’
suggest several nursing interventions
1.
Alterations in body temperature
2.
Ineffective breathing pattern
3.
Activity intolerance
4.
Alteration in comfort
5.
Alteration in thought processes
Hyperthyroidism: Grave’s disease. Most often affects women aged 30-50. The
primary dysfunction is excess secretion of thyroid hormones.
Clinical Manifestations
Nervousness,
Irritable
hyperexcitable
Rapid pulse (90-160)
Amenorrehea
Excess perspiration
Flushed skin
Increased appetite
Decreased weight
Palpitations
Poor heat tolerance
Exopthalmus
Fatigability/weakness
Management: Goal restore metabolic rate
Radioactive iodine treatment: destroy overactive thyroid cells.
 70-85% patients cured with one dose
 high incidence of hypothyroidism
 patient/family fear of radioactive component
Nursing Considerations: On the following table, identify 4 nursing diagnosis that
are related to hyperthyroidism and such at least 3 sound nursing interventions to address
each.
Nursing Diagnosis
1.
Interventions
a)
b)
c)
d)
2.
a)
b)
c)
d)
3.
a)
b)
c)
d)
4.
a)
b)
c)
d)
Thyroid storm (Thyrotoxic Crisis)
A form of severe hyperthyroidism. Onset is abrupt and condition is life-threatening.
Causes include: physical and emotional stress (injury, infection, surgery), and abrupt
withdrawal from antithyroid medications.
Manifestations
Pyrexia (>38.5)
Tachycardia (>130/min)
Delirium
Exaggerated hyperthyroid
Disturbance of major systems
symptoms
(digestive, CV, neur)
Management
 Oxygen therapy, humidified (to meet demand of high metabolic rate)
 Monitor oxygen saturation rate (pulse oximetry, arterial blood gas)
 Medication
o Non-ASA antipyretic medication/ therapy
o Hydrochorithiazide to treat adrenal insufficiency
o Propranolol and digitalis to reduce cardiac symptoms
o Agents to impede conversion of T4 to T3
Adrenal Gland: Adrenal cortex
Definition
Clinical Manifestations
Diagnostic findings
Management
Nursing Considerations
Addison’s Disease
Insufficient
Insufficient corticosteroid
and mineralcorticoid
production
Muscle weakness, fatigue,
dark pigmentation of skin,
hypotension, GI
disturbance, severe wt loss,
hypoglycemia,
hyponatremia,
hyperkalemia.
Decreased serum Na and
Bl.g
Low plasma catecholemines
and cortisol
Addisonian Crisis:
hypotensive crisis.
 Hydrocortisone
 Increase BP
 Fluid replacement
 Gl and elect.
replacement
Monitor for Addisonian
Crisis
Assess stress levels and
coping strategies.
Risk for fld volume def.
Risk for infection
Activity intolerance.
Health teaching re: possible
hormone replacement
therapy.
Cushing’s Disease
Excess
Excess corticosteroid and
mineralcorticoid production
Moon face
Central obesity: buffalo
hump, pendulous abdomen.
Skin: thin, fragile, oily,
acne
Muscle wasting,
osteoporosis
Na retention
Hyperglycemia
Decreased libido
Virilization of women
Increased Na and Bl.g
Decreased K
Surgical removal of tumor
if cause is pituitary tumor.
Adrenalectomy is cause is
adrenal tumor
Risk for injury
Provide high protein, Ca,
and vit D diet. Reduce Na
and caloric intake.
Risk for infection
Impaired skin integrity
Altered body image/selfesteem