endocrine
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TRANSCRIPT
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ALTERATION IN REGULATIONENDOCRINE DISORDERS
C. Washington RN, MSNEd
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Thyroid Gland
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Thyroid Disorders Thyroid Gland
produces three hormones: Thyroxine (T4) Triiodothyronine (T3) Calcitonin T3 + T4 are referred to
collectively as thyroid hormone.
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Thyroid-iodine connection Iodine is used by the thyroid to produce
its hormones T4 - thyroxineT3 - triiodothyronineCalcitonin
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Calcitonin Secreted by the thyroid gland. Secreted in response to high plasma
levels of calcium Decreases circulating plasma Ca++ levels
by increasing its deposition in bone
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Thyroid Hormone: HypofunctionSubjective:• Fatigue, weakness, forgetfulness, Objective:• Labile BP, CO, bradycardia, MI d/t
hyperlipidemia, constipation, weight gain, cold intolerance, prone to infections, depression, anxiety,
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Thyroid Hormone: HyperfunctionSubjective:• Palpitations, fatigueObjective:• HTN, HR, RR & CO, arrythmias, diarrhea,
weight loss, heat intolerance, fine tremors, labile moods, insomnia, exhaustion,
• Goiter, exothalmus
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Goiter
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Nursing Diagnosis of Thyroid Dysfunction
Altered metabolic function
Activity intolerance Impaired cardiac
output Imbalanced
nutrition
Anxiety Potential for injury Hypo/hyperthermia Disturbed thought
process Knowledge deficit
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Nursing Management of Thyroid Dysfunction
Goal: Restore normal/optimal metabolic state Prevent complications
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Abnormal Thyroid Function Hypothyroidism
the thyroid releases too little hormone so the body's metabolism goes too slowly
Hyperthyroidism where the thyroid releases too much
hormone and the body's metabolism goes too fast
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Abnormal Thyroid Function Thyroid nodules and swellings
overgrowth of thyroid tissue resulting in a nodule or small lump, in
part of the gland a small percentage of the inactive lumps
may be cancerous
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Hypothyroidism Hypothyroidism
The body's normal rate of functioning slows, causing mental and physical sluggishness
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Thyroiditis
Inflammation of the thyroid gland
Hashimoto’s Disease Chronic thyroiditis Reaction of the
immune system against the thyroid gland
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Hypothyroidism Fatigue or lack of
energy Weight gain Feeling cold Dry skin and hair
Heavy menstrual periods
Constipation Slowed thinking
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Hyperthyroidism 2nd most common endocrine disorder (after diabetes
mellitus)
Graves’ Disease Excessive output of thyroid hormone caused by abnormal
stimulation of the thyroid gland by circulating immunoglobulins
Other causes Thyroiditis Excessive ingestion of thyroid hormone
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Hyperthyroidism Jitteriness, shaking,
increased nervousness, irritability
Rapid heart beat or palpitations
Feeling hot Weight loss
Fatigue, feeling exhausted
More frequent bowel movements
Shorter or lighter menstrual periods
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Nursing Management: Hyperthyroidism
Reducing thyroid hyperactivity to relieve symptoms and accompanying complications
Radioactive Iodine (RAI) Disrupts the function of some of the thyroid cells Given as a single dose Low side effects
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Collaborative Management: Hyperthyroidism
Medications Require long-term compliance High rate of relapse
Surgery Subtotal thyroidectomy
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Thyroidectomy
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Parathyroid Glands
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Parathyroid Glands
Secretes parathormone (PTH)
PTH regulates calcium and phosphorous
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Parathyroid and Calcium Regulation
Calcium most closely regulated element in our bodies!
important in conduction of electrical impulses in nervous and muscular systems
ONLY element / mineral that has its own regulatory system the parathyroid glands
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Hyperparathyroidism Increase in the production of PTH
Due to a benign growth of 1:4 parathyroid glands
Induces: abnormally high serum Ca++ levelsbone decalcificationdevelopment of kidney stones
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Hyperparathyroidism Fatigue Apathy muscle weakness Vomiting Hypertension Bone
demineralization kidney stones
Symptoms of have become
known as: "moans, groans,
stones, and bones...with psychic overtones".
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Hypoparathyroidism Accidental removal
of parathyroid glands during thyriod surgery
Symptoms r/t hypocalcemia & hyperphosphatemia Neuromuscular
irritability
TetanyNumbness,
tingling, cramps Bronchospasm,
laryngeal spasm, carpopedal spasm
Ca+ Gluconate
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Hypoparathyroidism Trousseau’s Sign of latent tetany
Compression of the forearm in clients having undue neuromuscular excitability due to hypocalcaemia produces spasm in the hand and wrist.
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Hypoparathyroidism Chvostek’s sign of latent tetany
contraction of the muscles of the eye, mouth or nose, elicited by tapping along the course of the facial nerve.
The examiner taps gently over the facial nerve in front of the ear.
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Nursing care of parathyroid dysfunction
Subjective & objective data similar to thyroid dysfunction
Blood level >10 or < 3 very significant
Nursing Diagnosis Altered metabolism Altered cardiac
output Anxiety Altered comfort Impaired memory
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Corticosteroid Therapy “Steroids” Used to treat adrenal insufficiency
Suppress inflammation & autoimmune reactions, control allergic reactions & reduce organ transplant rejection
Side effects of high doses over long-term turned steroid use into “scare-oids”
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“Steroids” - How do they work?
Cortisol controls salt & water balance in the body Stress pituitary gland releases
adrenocorticotropic hormone (ACTH) which stimulates adrenals to produce cortisol
Extra cortisol allows body to cope with stress of infections, trauma, surgery, or emotional problems
When stressful situation resolves, adrenal hormone function returns to normal
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Corticosteroid Therapy Block production of substances that trigger
allergic and inflammatory actions (i.e. prostaglandins).
Impede the function of WBC’s which help keep the immune system functioning properly
Undesirable side effect: susceptibility to infection