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56 Cards in this Set
- Front
- Back
Endocrine System
Assess for |
Health hx:
fatigue and energy level affects on ADLs Tolerance to heat and cold changes in weight Changes in sexual function and secondary characteristics. changes in mood memory and ability to concentrate and altered sleep patterns. |
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Calcitonin: or thyrocalcitonin.
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Secreted in response to high plasma levels of calcium, and it reduces the plasma level of calcium by increasing its deposition in bone.
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T4
Function |
weak, maintains body metabolism in a steady state.
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T3
function |
5x potent, more rapid metabolic action.
•Influence cell replication and are important in brain development. •Necessary for normal growth. •Widespread effects on cellular metabolism, influence every major organ system. |
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Cretinism
fetal |
because of general depression of metabolic activity during fetal and neonatal development, results in stunted physical and mental growth.
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Cretinism
Adults- |
manifests as lethargy, slow mentation, and generalized slowing of body functions.
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Hypothyroidism
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•Results from the suboptimal levels of hormone.
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Hypothyroidism
•Common cause in adults; |
autoimmune thyroiditis.
Hyper can lead to Hypo. |
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Hypothyroidism
Clinical Manifestations |
Fatigue
dry skin/nails hair loss menstrual changes constipation. |
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Hypothyroidism
Clinical Manifestations Severe |
subnormal temp and pulse rate
Mental and personality changes elev cholesterol atherosclerosis CAD poor LVF. |
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Extreme Hypothyroidism
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myxedema
hypothermic unconscious |
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Synthroid/Levothroid.
•Drug interactions: |
hypoglycemics
dilantin digoxin tricyclic antidep anticoag NSAIDs sedative/hypnotic agents |
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Hypothyroid
Supportive therepy |
–ABGs, for CO2 retention, possible ventilation
–Fluids, caution; danger of water intoxicaiton. –Avoid heating pads; increases O2 requirement and may lead to vascular collapse. –BS; hypoglycemia, use concentrated glucose to avoid fld overload –Myxedema; IV Levothyroxine cautiously until consciousness is restored. |
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Hypothyroidism
Elderly |
fatigue
muscle aches mental confusion depression apathy decreased mobility or activity significant wgt loss and constipation |
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Hyperthyroidism
caused by |
abnormal stimulation of the thyroid gland by circulating immunoglobulin
Emotional shock, stress, or infection thyroiditis and excessive ingestion of thyroid hormone |
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Hyperthyroidism
clinical manifestations |
Nervousness, emotionally hyperexcitable, irritable, and apprehensive. Palpitations, pulse rapid at rest. Tolerate heat poorly tolerated and perspire unusually freely
Skin is flushed and salmon color. |
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Hyperthyroidism
clinical manifestations Elderly: |
dry skin
diffuse pruritus fine tremor of hands exophthalmos |
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Hyperthyroidism
Assessment Findings |
Enlarged thyroid
–Soft and may pulsate –Bruit over the thyroid arteries |
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Hyperthyroidism
Diagnostic findings |
–Decreased TSH
–increased T4 –increase in radioactive iodine uptake. |
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THYROID STORM:
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severe disease, usually abrupt onset
Fatal if untreated. high fever extreme tach (>130) altered mental state (delirium psychosis, somnolence, coma) GI (wgt loss, diarrhea, abd pain) CV (edema, cp, dyspnea, palpitations) |
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Anti Thyroid med used during pregnancy
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PTU
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Thyroiditis
•Acute, subacute, chronic |
•Characterized by: inflammation, fibrosis or lymphocytic infiltration.
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Acute Thyroiditis
Caused by |
bacteria (staph aureus), fungi, mycobacteria or parasites
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Acute Thyroiditis
s/s |
Anterior neck pain
swelling fever dysphagia dysphonia pharyngitis or pharyngeal pain. warmth erythema tenderness |
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Acute Thyroiditis
tx |
antibiotics
fluid replacement surgical rx for abscess. |
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Medulla gland secretes
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catecholamines
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Cortex outer gland secretes
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steroid hormones
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Catecholamines:
function |
regulate metabolic pathways to promote catabolism of stored fuels to meet caloric needs, prepares to meet a challenge (fight or flight response)
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Adrenal Cortex
3 types of hormones: |
Glucocorticoids
Mineralocorticoids Adrenal sex hormones (Androgens) |
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Glucocorticoids:
function |
important influence on glucose metabolism (elevating blood glucose levels). Secreted in response to ACTH. In the form of corticosteroids are used to inhibit inflammation and suppress allergic manifestations.
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Glucocorticoids:
Side Effects |
development of diabetes, osteoporosis, peptic ulcer, increased protein breakdown and redistribution of body fat.
Large doses can inhibit the release of ACTH and endogenous glucocorticoids. Result in atrophy and insufficiency. |
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Mineralocorticoids:
function |
major effects on electrolyte metabolism.
Secreted in response to Angiotensin II, elevates B/P, concentration is increased when renin is released in response to decreased perfusion pressure. Release is also increased by hyperkalemia Aldosterone; long-term regulation of sodium of sodium balance. |
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Adrenal Sex Hormones
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Exert effects similar to that of the male sex hormone
Small amts of Estrogen ACTH controls secretion Normal amounts of un-noticeble effects, excess amt- masculainization |
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Pheochromoytoma
overview |
-orinates in the Adrenal medulla
- Usually benign - familial -occurs with multiple endocrine neoplasia type 2 |
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Multiple endocrine neoplasia type 2
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medullary thyroid carcinoma, parathyroid hyperplasia or tumor.
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Pheochromoytoma
clinical manifestations |
-Headache
-diaphoresis -Palpatations with HTN -Other(hyperglycemia, vertigo, blurring, tinnitus, air hunger, polyurina, N/V/D, feeling of impending doom, tachycardia. |
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Pheochromoytoma
assessment and dx findings |
-5 H's
-HTN -HA -Hyperhydrosis -hyper metabolism -hyperglycemia 24 urine for catecholamines and metanephrines CT/MRI |
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Can effect 24 hour urine results
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-caffeine
-tobacco -amphetimines -decongestants -bronchodilators -stress |
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Pheochromoytoma
medical management |
-dx
-EKG monitoring -Phenoxybenamine -nifedipine -Adrenalectomy |
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Phenoxybenamine
desired effect |
dizziness
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Addison's Ds
overview |
-adrenal insufficiency
-autoimmine or idopathis -surgical removal of both adrenal glands causes this |
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Addison's Ds
most common cause |
therapeutic use of corticosteroids.
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Addison's Ds
clincal manifestations |
-muscle weakness
-anorexia -GI disturbance -fatigue -emaciation -dark mucous menbranes/skin -hypotension -low BS -mental status change -depression -emotional lability -apathy confusion |
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Addisons Ds
Severe cases |
chronic dehydration due to marked depletion of Na and water due to disturbance in metabolism.
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Addison's Crisis
clinical manifestations |
-cyanosis
-shock(pallor, apprehension, rapid/weak pulse, rapid respirations, low BP) -Ha -N/V/Abd pain/D -confusion -death |
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Addison's crisis
medical management |
-24 hour urine
- prevent shock with IV fluids -recumbant position legs up -hydrocortisone IV -vasopressin for hypotension -abx - adrenal replacement |
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Addison's Crisis
RN management |
-Assessment
- Restore fluid balance -improve activity intolerance - promoting home care |
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Cushings Syndrome
overview |
- Results from excessive activity
- caused by corticosteroids - pituitary tumor prodices ACTH and stimulates thae cortex to increase hormone secretion - normal feedback mechinisms become ineffective and the usual diurnal pattern of cortisol is lost |
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Cushings Syndrome
clincal manifestations |
-arrest in growth
-obesity - MS changes with glucose intolerance -buffalo hump -fragile skin -muscle weakness/wasting -nocturnal diuresis - osteoporosis - kyphosis - retention of Na and water -HTN -HF -Moon face -Suseptible to infection - hyperglycemia or DM -hirsutism -psychosis(long term) |
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Cushings Syndrome
assessment and dx findings |
-dexamethasone testing(most sensistive)
- plasma and urine cortisol levels (inc) - electrolytes -CT/MRI for tumor -24 hour urine |
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Cushings Syndrome
medical managment |
-surgical removal of adrenal gland
-reduce the corticosteroid |
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Aldosterone
overview |
-conserve body sodium
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Primary Aldosteronism
overview |
- kidneys excrete less NA and more potassium and hysrogen
- excessive productionr/t to timors -causes a pattern of biochemical changes and a corresponding set of clinical signs. |
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Primary Aldosteronism
clincal manifestations |
-profound decline in K and hydrogen
-Increase PH and biacarbonate -HTN -polyuria -polydypsia |
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Hypokalemia
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-muscle weakness
-cramping -fatigue -glucose intolerance |
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Primary Aldosteronism
assessment/dx findings |
-inc Na
-dec k -inc aldosterone -low renin -adrenal venous sampling bilaterally* -adrenalectomy tx |