alteration in endocrine system

Medical-Surgical NursingAilyn Pineda

Review of the Anatomy and Physiology of the endocrine glands

Review of the Common Laboratory procedures

Review of the Common endocrine disorders

Review of Diabetes Mellitus

The endocrine system is composed of ductless glands that release their hormones directly into the bloodstream

The Hypothalamus controls most of the endocrinal activity of the pituitary gland

The pituitary gland controls most of the activities of the other endocrine glands

Hypothalamus

Pituitary Gland

Endocrine gland

Increased Hormones

The HypothalamusThis part of the DIENCEPHALON is located below the thalamus and is connected to the pituitary gland by a stalk

Secretes RELEASING HORMONES for the pituitary gland

Releasing hormones= hypothalamus

Secretes OXYTOCIN that is stored in the Posterior pituitary gland

Secretes Anti-Diuretic Hormone or VASOPRESSIN that is stored also in the posterior pituitary gland

The Pituitary GlandIs a gland located below the hypothalamus at the base of the brain

The Pituitary GlandThe optic chiasm passes over this structure

The Pituitary GlandIs divided into two parts- the anterior or adenohypophysis and the posterior or the neurohypophysis

Secretes the following hormones:

1. Growth hormone2. Prolactin

Secretes the following hormones:3. Gonadotrophins- LH and FSH

4. Stimulating hormones and trophic hormones◦ACTH◦TSH◦MSH

Stores and releases1. OXYTOCIN2. ADH/Vasopressin

The THYROID glandLocated in the anterior neck lateral to the trachea

The THYROID glandContains two lobes connected by the isthmus

Microscopically composed of thyroid follicles where the hormones are produced and stored

Produces the thyroid hormones by the thyroid follicles:1. Tri-iodothyronine or T32. Tetra-iodothyronine or thyroxine or T4

The Parafollicular cells secrete CALCITONIN

The PARAthyroid glandsLocated at the back of the thyroid glands

Four in number

Secretes PARATHYROID hormone (PTH) that controls calcium and phosphorus levels

PTH is stimulated by a DECREASED Calcium level

Parathyroid Hormone is released in HYPOCALCEMIA

Calcitonin is stimulated by HYPERCALCEMIA

Parathyroid hormone is NOT secreted in HYPERCALCEMIA

Calcitonin is inhibited by HYPOCALCEMIA

The Adrenal GlandsLocated above the kidneysComposed of two parts- the outer Adrenal Cortex and the inner Adrenal medulla

Secretes three types of STEROID hormones

1. Glucocorticoids- like Cortisol, cortisone and corticosterone

Secretes three types of STEROID hormones

2. Mineralocorticoids- like Aldosterone

3. Sex hormones- like estrogen and testosterone

Essentially a part of the SYMPATHETIC autonomic system

Secretes Adrenergic Hormones:

1. Epinephrine2. Nor-epinephrine

The PancreasThis retroperitoneal organ has both endocrine and exocrine functions

The PancreasThe endocrine function resides in the ISLETS of Langerhans

The islets have three types of cells- alpha, beta and delta cells

The ALPHA cells secrete GLUCAGON

The BETA cells secrete INSULIN

The DELTA cells secrete SOMATOSTATIN

The GONADS- OvariesThese two almond-shaped glands are found in the pelvic cavity attached to the uterus by the ovarian ligament

The GONADS- TestesThese two oval-shaped glands are found in the scrotum

The Ovaries contains Granulosa and Theca cells which secrete ESTROGEN and Progesterone

The testes contains Leydig cells that secrete Testosterone

COMMON LABORATORY PROCEDURES

Hormone Levels AssayThese are blood examinations for the levels of individual hormones

Hormone Levels AssayMeasurements can also be done after stimulation and suppression of the secretions- Stimulation and Suppression tests

Hormone Levels of T3/T4

Usually done to diagnose hypo/hyperthyroidism


If T3 is elevated, T4 is elevated and TSH is depressed Primary HYPERthyroidism


If T3 is depressed,T4 is depressed and TSH is elevated Primary HYPOthyoidism

Radio-Active iodine uptake (RAI)

This is a thyroid function test to measure the absorption of the injected iodine isotope by the thyroid tissue

Radio-Active iodine uptake (RAI)

Increased uptake may indicate HYPERfunctioning gland

Decreased uptake my indicate HYPOfunctioning gland

Thyroid ScanPerformed to identify nodules or growth in the thyroid gland

RAI is used

Thyroid ScanPretest- Check for pregnancy, Thyroid medication may be withheld temporarily, advise NPO

Post-test- Ensure proper disposal of body wastes

The BMR has a long history in the evaluation of thyroid function. It measures the oxygen consumption under basal conditions of overnight fast and rest from mental and physical exertion. it can be estimated from the oxygen consumed over a timed interval by analysis of samples of expired air

BMRThe test indirectly measures metabolic energy expenditure or heat production.Results are expressed as the percentage of deviation from normal after appropriate corrections have been made for age, sex, and body surface area.Low values are suggestive of hypothyroidism, and high values reflect thyrotoxicosis.

FASTING BLOOD GLUCOSEAids in the diagnosis of Diabetes

Pre-test: NPO for 8 hoursNormal FBS- 80-109 mg/dLDM- 126 mg/dL and above

GLUCOSE tolerance testAids in the diagnosis of DMPre-test: Provide high-carbohydrate foods x 3 days, instruct to avoid caffeine, alcohol and smoking, NPO 10 hours prior to test

GLUCOSE tolerance testPost-test: avoid strenuous activity for 8 hours

Normal OGTT- 1 and 2 hours post-prandial- glucose is less than 200 mg/dL

Glycosylated Hemoglobin A 1-C

Blood glucose bound to RBC hemoglobin

Reflects how well blood glucose is controlled for the past 3 months

FASTING is NOT required!

Glycosylated Hemoglobin A 1-CNormal level- expressed as percentage of total hemoglobin

N- 4-7%Good control- 7.5%or lessFair control- 7.5 % to 8.9%Poor control- 9% and above

Disorders are generally grouped into:

1. HYPER- when the gland secretes excessive hormones

2. HYPO- when the gland does not secrete enough hormones

Hyper and Hypo can be classified as PRIMARY when the Gland itself is the problem or SECONDARY when the pituitary or the hypothalamus is causing the problem

PITUITARY GLAND

HYPOPITUITARISMHyposecretion of the anterior pituitary gland

CAUSES: Congenital, Post-partal necrosis, infection and tumor

HYPOPITUITARISMPATHOPHYSIOLOGY:Depends on the major hormone/s depleted

Hypopituitarism: ASSESSMENT Findings

1. Retarded physical growth due to decreased GH dwarfism

2. Low intellectual development3. poor development of secondary sexual characteristics

NURSING INTERVENTIONS1. Provide emotional support to the family

2. Encourage client and family to express feelings

3. Administer prescribed hormonal replacement therapy

HYPERPITUITARISMThe hyper-secretion of the gland

ACROMEGALYCAUSES: tumor, congenital disorder

HYPERPITUITARISMPATHOPHYSIOLOGYDepends on the hormone/s that is/are increased

ASSESSMENT FINDINGS for Hyper-pituitarism

1. Increased growth Gigantism or Acromegaly

2. large and thick hands and feet

ASSESSMENT FINDINGS for Hyper-pituitarism

3. Visual disturbances4. Hypertension, hyperglycemia

5. Organomegaly

NURSING INTERVENTIONS1. Provide emotional support to clients and family

2. Provide frequent skin care3. Prepare patient for surgery- removal of pituitary gland

NURSING INTERVENTIONSPost-operative care1. Monitor VS, LOC and neurologic status

2. Place patient on Semi-Fowler’s

NURSING INTERVENTIONSPost-operative care3. Monitor for Increased ICP, bleeding, CSF leakage

4. Instruct patient to AVOID sneezing, coughing and nose-blowing

NURSING INTERVENTIONSPost-operative care5. Monitor development of DI- measure I and O

6. Administer prescribed medications- antibiotics, analgesics and steroids

DIABETES INSIPIDUSA hypo-secretion of ADHCAUSES: Conditions that increase ICP, Surgical removal of post pit. tumor

DIABETES INSIPIDUSPATHOPHYSIOLOGY Decreased ADH failure of tubular re-absorption of water increased urine volume

ASSESSMENT findings

1. Polyuria of more than 4 liters of urine/day

2. Polydipsia

ASSESSMENT findings3. Signs of Dehydration4. Muscle pain and weakness

5. Postural hypotension and tachycardia

DIAGNOSTIC TEST1. Urinary Specific gravity very low, 1.006 or less

2. Serum Sodium levels high

NURSING INTERVENTIONS1.Monitor VS, neurologic status and cardiovascular status

2. Monitor Intake and Output

3. Monitor urine specific gravity

NURSING INTERVENTIONS4. Provide adequate fluids5. Administer Chlorpropamide or Clofibrate as prescribed to increase the action of ADH if decreased

NURSING INTERVENTIONS6. Administer VASOPRESIN. Desmopressin or Lypressin are given intranasal. Pitressin is given IM

SIADHHyper-secretion of ADH abnormally

CAUSES: tumor, paraneoplastic syndromes

SIADHPATHOPHYSIOLOGYIncreased ADH water re-absorption water intoxication, hypervolemia

DIAGNOSTIC TEST for SIADH

1. Urine specific gravity is increased (concentrated)

2. Hyponatremia3. CBC shows hemodilution

ASSESSMENT findings1. Signs of Hypervolemia

2. Mental status changes

3. Abnormal weight gain

ASSESSMENT findings4. Hypertension5. Anorexia, Nausea and Vomiting

6. HYPOnatremia

NURSING INTERVENTIONS1. Monitor VS and neurologic status

2. Provide safe environment3. Restrict fluid intake (less than 500cc/day)

NURSING INTERVENTIONS4. Monitor I and O and daily weight

5. Administer Diuretics and IVF carefully

6. Administer prescribed Demeclocycline to inhibit action of ADH in the kidney

ADRENAL GLAND

Hypo-secretion: ADDISON’S Disease

Decreased secretion of adrenal cortex hormones, especially glucocorticoids and mineralocorticoids

CAUSE: tumor, idopathic

PATHOPHYSIOLOGYDecreased Glucocorticoids decreased resistance to stress

PATHOPHYSIOLOGYDecreased mineralocorticoids decreased retention of sodium and water

Hypovolemia

Normal functions of Cortisol

HYPO functions

1. Gluconeogenesis HYPOGLYCEMIA

Functions of Mineralocorticoids

HYPO functions

1. Sodium Retention HYPOnatremia

2.Secondary water retention

HYPOvolema- HYPOtensionWeight LOSS

3. Potassium excretion

HYPERKALEMIA

Function of androgen:Libido

Decreased libido

ASSESSMENT Findings for Addison’s disease

1. Weight loss2. GI disturbances3. Muscle weakness, lethargy and fatigue

4. Hyponatremia

ASSESSMENT Findings for Addison’s disease

5. Hyperkalemia6. Hypoglycemia7. dehydration and hypovolemia

8. Increased skin pigmentation

NURSING INTERVENTIONS1. Monitor VS especially BP 2. Monitor weight and I and O3. Monitor blood glucose level and K

4. Administer hormonal agents as prescribed

NURSING INTERVENTIONS5. Observe for ADDISONIAN crisis

6. Educate the client regarding lifelong treatment, avoidance of strenuous activities, stress and seeking prompt consult during illness

NURSING INTERVENTIONS7. Provide a high-protein, high carbohydrate and increased sodium intake

ADDISONIAN crisisA life-threatening disorders caused by acute severe adrenal insufficiency

CAUSES: Severe stress, infection, trauma or surgery

ADDISONIAN crisisPATHOPHYSIOLOGYOverwhelming stimuli mobilize body defense decreased stress hormones inadequate coping

ASSESSMENT Findings for Addisonian Crisis= “severe lahat”

1. Severe headache2. Severe pain3. Severe weakness4. Severe hypotension5. Signs of Shock

NURSING INTERVENTIONS1. Administer IV glucocorticoids, usually hydrocortisone

2. Monitor VS frequently3. Monitor I and O, neurological status, electrolyte imbalances and blood glucose

NURSING INTERVENTIONS4. Administer IVF5. Maintain bed rest6. Administer prescribed antibiotics

Hyper-secretion: CUSHING’S DISEASE

A condition resulting from the hyper-secretion of glucocorticoids from the adrenal cortex

CAUSES: Pituitary tumor, adrenal tumor, abuse of steroids

Hyper-secretion: CUSHING’S DISEASE

PATHOPHYSIOLOGYIncreased Glucocorticoids exaggerated effects of the hormone

Normal functions of Cortisol

Exaggerated functions

1. Gluconeogenesis HYPERGLYCEMIA

2. Protein breakdown

OSTEOPOROSISS, delayed wound healingPurplish striae , BleedingMuscle wasting

3. Fat breakdown THIN extremity, Truncal deposition

4. Decreased WBC IMMUNOSUPPRESSION

Functions of Mineralocorticoids

Exaggerated functions

1. Sodium Retention Hypernatremia

2.Secondary water retention

Hypervolema- Hypertension

3. Potassium excretion

HYPOKALEMIA

Function of androgen: Hair growth

HIRSUTISM

ASSESSMENT FINDINGS for Cushing

1. Generalized muscle weakness and wasting

2. Truncal obesity


3. Moon-face4. Buffalo hump5. Easy bruisability


6. Reddish-purplish striae on the abdomen and thighs

7. Hirsutism and acne8. Hypertension


9. Hyperglycemia10. Osteoporosis11. Amenorrhea

DIAGNOSTIC TESTS1. Serum cortisol level

2. Serum glucose and electrolytes

NURSING INTERVENTIONS1. Monitor I and O , weight and VS

2. Monitor laboratory values- glucose, Na, K and Ca

NURSING INTERVENTIONS3. Provide meticulous skin care

4. Administer prescribed medications like aminogluthetimide to inhibit adrenal hyperfunctioning

NURSING INTERVENTIONS5. Prepare client for surgical management- pituitary surgery and adrenalectomy

6. Protect patient from infection

NURSING INTERVENTIONS7. Improve body image8. Provide a LOW carbohydrate, LOW sodium and HIGH protein diet

Hyper-secretion: CONN’S DISEASE

Hyper-secretion of Aldosterone from the adrenal cortex

CAUSES: pituitary tumor, adrenal tumor

Hypersecretion: CONN’S DISEASE

PATHOPHYSIOLOGYIncreased Aldosterone exaggerated effects

ASSESSMENT findings in CONN’S disease

1. Symptoms of HYPOkalemia

2. Hypertension3. Hypernatremia

ASSESSMENT findings in CONN’S disease

4. Headache, N/V5. Visual changes6. Muscles weakness, fatigue and nocturia

DIAGNOSTIC TEST1. Urine gravity- low (due to polyuria)

2. Serum Sodium- high3. Serum Potassium- very low4. Increased urinary Aldosterone

NURSING INTERVENTIONS1. Monitor VS, I and O and urine sp gravity

2. Monitor serum K and Na3. Provide Potassium rich foods and supplements

NURSING INTERVENTIONS4. Administer prescribed diuretic- Spironolactone

5. Maintain sodium-restricted diet

NURSING INTERVENTIONS

6. Prepare patient for possible surgical interventions

Hyper-secretion: Pheochromocytoma

Increased secretion of epinephrine and nor-epinephrine by the adrenal medulla

CAUSE: tumor

Hypersecretion: Pheochromocytoma

PATHOPHYSIOLOGYIncreased Adrenergic hormones exaggerated sympathetic effects

ASSESSMENT Findings in Pheochromocytoma

1. Hypertension2. Severe headache3. Palpitations4. Tachycardia

ASSESSMENT Findings in Pheochromocytoma

5. Profuse sweating and Flushing

6. Weight loss, tremors7. Hyperglycemia and glycosuria

NURSING INTERVENTIONS1. Monitor VS especially BP

2. Monitor for HYPERTENSIVE crisis

3. Avoid stimulation that can cause increased BP

NURSING INTERVENTIONS4. Administer Anti-hypertensive agents like alpha-adrenergic blockers- Phenoxybenzamine

5. Prepare Phentolamine for hypertensive crisis

6. Monitor blood glucose and urine glucose

7. Promote adequate rest and sleep periods

8. provide HIGH calorie foods and Vitamins/mineral supplements

9. Prepare patient for possible surgery

THYROID GLAND

HYPOsecretion: HYPOTHYROIDISMA hypothyroid state characterized by decreased secretions of T3 and T4

CAUSES: Hypofunctioning tumor, IDG, Pituitary tumor, Ablation therapy, Surgical removal of thyroid

HYPOsecretion: HYPOTHYROIDISM

PATHOPHYSIOLOGYDecreased T3 and T4 decreased basal metabolism

ASSESSMENT findings for Hypothyroidism

1. Lethargy and fatigue2. Weakness and paresthesia

3. COLD intolerance


4. Weight gain5. Bradycardia, constipation


6. Dry hair and skin, loss of body hair

7. Generalized puffiness and edema around the eyes and face


8. Forgetfulness and memory loss

9. Slowness of movement10. Menstrual irregularities and cardiac irregularities

NURSING INTERVENTIONS1. Monitor VS especially HR2. Administer hormone replacement: usually Levothyroxine( Synthroid)-should be taken on an empty stomach

NURSING INTERVENTIONS3. Instruct patient to eat LOW calorie, LOW cholesterol and LOW fat diet

4. Manage constipation appropriately

5. Provide a WARM environment

NURSING INTERVENTIONS6. Avoid sedatives and narcotics because of increased sensitivity to these medications

7. Instruct patient to report chest pain promptly

HYPERfunctioning: HYPERTHYROIDISM

Called GRAVE’S DISEASEA hyperthyroid state characterized by increased circulating T3 and T4

HYPERfunctioning: HYPERTHYROIDISM

CAUSES: Auto-immune disorder, toxic goiter and tumor

PATHOPHYSIOLOGYIncreased hormone activity increased Basal Metabolism

ASSESSMENT Findings for Hyperthyroidism

1. Weight loss2. HEAT intolerance3. Hypertension


4. Tachycardia and palpitations

5. Exopthalmos6. Diarrhea


7. Warm skin8. Diaphoresis9. Smooth and soft skin

◦Oligomenorrhea to amenorrhea


10. Fine tremors and nervousness

11. Irritability, mood swings, personality changes and agitation

NURSING INTERVENTIONS1. Provide adequate rest periods in a quiet room

2. Administer anti-thyroid medications that block hormone synthesis- Methimazole and PTU

3. Provide a HIGH-calorie diet, HIGH protein

NURSING INTERVENTIONS 4. Manage diarrhea 5. Provide a cool and quiet environment

6. Avoid giving stimulants 7. Provide eye care

◦Hypoallergenic tape for eyelid closure

NURSING INTERVENTIONS7. Administer PROPRANOLOL for tachycardia

8. Administer IODIONE preparation- Lugol’s solution and SSKI to inhibit the release of T3 and T4

NURSING INTERVENTIONS9. Prepare clients for Radioactive iodine therapy

10. Prepare patient for thyroidectomy

11. Manage thyroid storm appropriately

Thyroid stormAn acute LIFE-threatening condition characterized by excessive thyroid hormone

Thyroid stormCAUSE: Manipulation of the thyroid during surgery causing the release of excessive hormones in the blood

ASSESSMENT Findings for Thyroid Storm

1. HIGH fever2. Tachycardia and Tachypnea

3. Systolic HYPERtension

ASSESSMENT Findings for Thyroid Storm

4. Delirium and coma5. Severe vomiting and diarrhea

6. Restlessness, Agitation, confusion and Seizures

NURSING INTERVENTIONS1. Maintain PATENT airway and adequate ventilation

2. Administer anti-thyroid medications such as Lugol’s solution, Propranolol, and Glucocorticoids

NURSING INTERVENTIONS3. Monitor VS4. Monitor Cardiac rhythms

5. Administer PARACETAMOL ( not Aspirin) for FEVER

NURSING INTERVENTIONS

6. Manage Seizures as required.

7. Provide a quiet environment

THYROIDECTOMYRemoval of the thyroid gland

PRE-OPERATIVE CARE - Thyroidectomy

1. Obtain VS and weight2. Assess for Electrolyte levels, glucose levels and T3/T4 levels

PRE-OPERATIVE CARE - Thyroidectomy

3. Provide pre-operative teaching like coughing and deep breathing, early ambulation and support of the neck when moving

4. Administer prescribed medications

POST-OPERATIVE CARE - Thyroidectomy

1. Position patient: Semi-Fowler’s, neck on neutral position

2. Monitor for respiratory distress- apparatus at bedside- tracheostomy set, O2 tank and suction machine!


3. Check for edema and bleeding by noting the dressing anteriorly and at the back of the neck


4. LIMIT client talking5. Assess for HOARSENESS

◦Expected to be present only initially, limit excess vocalization

◦If persistent, may indicate damage to laryngeal nerve!


6. Monitor for Laryngeal Nerve damage – Respiratory distress, Dysphonia, voice changes, Dysphagia and restlessness


7. Monitor for signs of HYPOCALCEMIA and tetany due to trauma of the parathyroid

8. Prepare Calcium gluconate9. Monitor for thyroid storm

Hypo-functioning: HYPOPARATHYROIDISM

Hypo-secretion of parathyroid hormone

CAUSES: tumor, removal of the gland during thyroid surgery

Hypo-functioning: HYPOPARATHYROIDISM

PATHOPHYSIOLOGYDecreased PTH deranged calcium metabolism

ASSESSMENT Findings for HypoParaThyroidism

1. Signs of HYPOCALCEMIA2. Numbness and tingling sensation on the face

3. Muscle cramps


4. (+) Trosseau’s and (+) Chvostek’s signs

5. Bronchospasms, laryngospasms, and dysphagia


6. Cardiac dysrhythmias7. Hypotension8. Anxiety, irritability ands depression

NURSING INTERVENTIONS1. Monitor VS and signs of HYPOcalcemia

2. Initiate seizure precautions and management

NURSING INTERVENTIONS3. Place a tracheostomy set. O2 tank and suction at the bedside

4. Prepare CALCIUM gluconate5. Provide a HIGH-calcium and LOW phosphate diet

NURSING INTERVENTIONS6. Advise client to eat Vitamin D rich foods

7. Administer Phosphate binding drugs

Hyper-functioning:HYPERPARATHYROIDISMHyper-secretion of the gland

CAUSE: Tumor

Hyper-functioning:HYPERPARATHYROIDISMPATHOPHYSIOLOGYIncrease PTH increased CALCIUM levels in the body

ASSESSMENT Findings for Hyperparathyroidism

1. Fatigue and muscle weakness/pain

2. Skeletal pain and tenderness

3. Fractures


4. Anorexia/N/V epigastric pain

5. Constipation


6. Hypertension7. Cardiac Dysrhythmias 8. Renal Stones

NURSING INTERVENTIONS1. Monitor VS, Cardiac rhythm, I and O

2. Monitor for signs of renal stones, skeletal fractures. Strain all urine.

NURSING INTERVENTIONS3. Provide adequate fluids- force fluids

4. Administer prescribed Furosemide to lower calcium levels

5. Administer NORMAL saline

NURSING INTERVENTIONS6. Administer calcium chelators

7. Administer CALCITONIN8. Prepare the patient for surgery

PHARMACOLOGY

Anti-diuretic hormonesEnhance re-absorption of water in the kidneys

Used in DI1. Desmopressin and Lypressin intranasally

2. Pitressin IM

Anti-diuretic hormonesSIDE-effectsFlushing and headacheWater intoxication

Thyroid hormonesLevothyroxine (Synthroid) and Liothyroxine (Cytomel)

Replace hormonal deficit in the treatment of HYPOTHYROIDSM

Thyroid hormonesSide-effects1. Nausea and Vomiting2. Signs of increased metabolism= tachycardia, hypertension

Thyroid hormonesNursing responsibility1. Monitor weight, VS2. Instruct client to take daily medication the same time each morning WITHOUT FOOD

Thyroid hormonesNursing responsibility3. Advise to report palpitation, tachycardia, and chest pain

4. Instruct to avoid foods that inhibit thyroid secretions like cabbage, spinach and radishes

ANTI-THYROID medicationsInhibit the synthesis of thyroid hormones

1. Methimazole (Tapazole)2. PTU (prophylthiouracil)3. Iodine solution- SSKI and Lugol’s solution

ANTI-THYROID medicationsSide-effectsN/VDiarrheaAGRANULOCYTOSIS

◦Most important to monitor

ANTI-THYROID medicationsNursing responsibilities1. Monitor VS, T3 and T4, weight

2. Take medications WITH MEALS to avoid gastric upset

ANTI-THYROID medicationsNursing responsibilities3. Instruct to report SORE THROAT or unexplained FEVER

4. Monitor for signs of hypothyroidism. Instruct not to stop abrupt medication

ANTI-THYROID medicationsLugol’s SolutionUsed to decrease the vascularity of the thyroid

T3 and T4 production diminishesGiven per orem, can be diluted with juice

Use straw

Replaces the steroids in the body

Cortisol, cortisone, betamethasone, and hydrocortisone

Side-effects◦HYPERglycemia◦Increased susceptibility to infection

◦Hypokalemia◦Edema

Side-effects◦If high doses- osteoporosis, growth retardation, peptic ulcer, hypertension, cataract, mood changes, hirsutism, and fragile skin

Nursing responsibilities1. Monitor VS, electrolytes, glucose2. Monitor weight edema and I/O

Nursing responsibilities3. Protect patient from infection4. Handle patient gently5. Instruct to take meds WITH MEALS to prevent gastric ulcer formation

Nursing responsibilities6. Caution the patient NOT to abruptly stop the drug

7. Drug is tapered to allow the adrenal gland to secrete endogenous hormones

Hyposecretion of thyroid hormones Common causes: Iodine deficiency, Hashimotos Manifestations: related to hypo-metabolic state:

constipation, weight gain, cold intolerance, poor appetite, mental slowness

Nursing Management:◦ Provide warm environment◦ LOW calorie diet, HIGH fiber◦ Avoid sedatives◦ Drugs: Hormone replacement

Hyper-secretion of thyroid hormones

Common cause: Graves, Toxic goiter

Manifestation: increased metabolism: weight loss, diarrhea, heat intolerance, hypertension

Nursing Management:◦Adequate rest and sleep◦Cool environment◦HIGH calorie foods◦Eye care◦Drugs: anti-thyroid: PTU and

methimazole, propranolol◦Care of patients after thyroidectomy

alteration in endocrine system

Documents

thyroid hormones

thyroid gland rai

posterior pituitary

pituitary gland controls

hyperfunctioning gland

sex hormones

following hormones

adrenergic hormones