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Endocrine 2

  1. Hyperpituitarism
    1. Definition - anterior pituitary secretes too much growth hormone and/or ACTH
    2. Etiology
      1. usually caused by benign neoplasm
      2. growth hormone overproduction: acromegaly
      3. ACTH overproduction leads adrenal gland to overproduce cortisone: Cushing's syndrome
    3. Findings
      1. may see signs of increased ICP
      2. acromegaly: excess longitudinal bone growth
      3. prognathism
      4. coarse facial features
      5. prominent forehead and orbital ridge
      6. large, broad, spade-like hands
      7. arthritis, kyphosis
    1. Diagnostics
      1. history and physical exam
      2. computerized tomogram (CT) scan
      3. plasma hormone levels: increased growth hormone, ACTH
    2. Management
      1. expected outcome: remove tumor and restore hormonal balance
      2. surgical removal of tumor
      3. irradiation of gland
      4. pharmacologic: growth hormone suppressant: bromocriptine (parlodel)
    3. Nursing interventions
      1. provide
        1. care of the client with increased ICP 
        2. care of the client undergoing surgery
        3. care of the client undergoing radiation therapy
        4. emotional support
      2. assess for signs of diabetes insipidus, since removal of a pituitary tumor may injure the posterior pituitary glands and decrease antidiuretic hormone (ADH) secretions
      3. teach client that treatment usually produces hypopituitarism so lifelong hormone replacement therapy with regular check-ups are required
  2. Disorders of the Posterior Pituitary
  3. Diabetes insipidus
    1. Posterior pituitary gland makes too little antidiuretic hormone(ADH). Body loses too much water in the urine; plasma osmolality and sodium levels increase.
    2. Etiology can include tumor, trauma, inflammation, or psychogenic causes.
    3. Findings
      1. excessive thirst (polydipsia)
      2. polyuria: as much as 20 liters per day with specific gravity below 1.006
      3. nocturia
      4. signs of dehydration
      5. constipation
    4. Diagnostics
      1. water deprivation tests: inability to concentrate urine
      2. osmotic stimulation
      3. administration of vasopressin (pitressin) or desmopressin acetate (stimate)
      4. computerized tomogram (CT) scan
    1. Management
      1. expected outcomes: to correct underlying cause and restore hormonal balance
      2. pharmacotherapy
        1. desmopressin acetate (stimate)
        2. vasopressin (pitressin) - antidiuretic hormone
        3. lypressin (diapid)
        4. chloropropamide (chloronase)
        5. clofibrate (claripex)
        6. carbamazapine (mazepine)
      3. IV fluid replacement therapy
      4. surgical removal of tumor
    2. Nursing interventions
      1. monitor for findings of dehydration; measure urine; specific gravity
      2. administer medications as ordered
      3. monitor fluids and give IV fluids as ordered
      4. measure intake and output
      5. weigh client daily
      6. care of the client with increased ICP 
      7. care of the client undergoing surgery
      8. teach client
        1. to record intake and output
        2. about medications and side effects
        3. to check urine specific gravity
        4. the need to wear disease identification jewelry

Disorders of the Thyroid Gland

    1. Hypothyroidism
      1. Definition - an underactive thyroid resulting in a lessened secretion of thyroid hormone
        1. deficiency of thyroid hormones causing decreased metabolic rate
          1. affects more women
          2. age group: 30 to 50 years of age
        2. classifications
          1. cretinism: hypothyroidism in children
          2. hypothyroidism without myxedema: mild thyroid failure
          3. hypothyroidism with myxedema: severe thyroid failure; usually seen in older adults
          4. myxedema coma
      1. Etiology
        1. thyroid surgery
        2. treatment for hyperthyroid condition
        3. overdosage of thyroid medications
        4. deficiency in dietary iodine
      2. Findings
        1. cognitive impairment
        2. constipation, fatigue, depression
        3. intolerance to cold
        4. coarse, dry skin; periorbitaledema; thick, brittle nails
        5. bradycardia; increased diastolicpressure
        6. menstrual changes - increased menstrual flow
        7. loss of the outer one-third of eyebrows
        8. weight gain
        9. fluid retention
      1. Diagnostics 
        1. history and physical exam
        2. increased TSH
        3. decreased serum T3 and T4
        4. anemia
        5. decreased basal metabolic rate (BMR)
        6. elevated cholesterol and triglycerides
        7. hypoglycemia
      2. Management
        1. expected outcomes: to restore hormonal balance and prevent complications
        2. administer synthetic thyroid hormone: levothyroxine sodium (levothroid)
        3. myxedema coma:
          1. IV fluids as ordered
          2. correct hypothermia
          3. give synthetic thyroid hormone
      3. Nursing interventions
        1. give medications as ordered
        2. watch client for signs of myxedema
        3. provide restful environment
        4. teach client
          1. how to conserve energy
          2. how to avoid stress
          3. about the medications and side effects - synthyroid is to be taken in the morning on an empty stomach at least one hour before any other medications or vitamins or ingestion of milk
          4. the importance of lifelong therapy
        5. protect client from cold
    2. Hyperthyroidism (Graves' disease, thyrotoxicosois)
      1. Definition - overactive thyroid over secretes hormones, and causes increased basal metabolic rate or hyperactivity of thyroid as a primary disease state
      2. Etiology - considered autoimmune response
        1. women affected more than men
        2. age group: 30 to 50 years
      3. Findings
        1. hyperphagia, weight loss, diarrhea
        2. heat intolerance
        3. exophthalmos
        4. tachycardia
        5. palpitations
        6. increased systolic BP
        7. difficulty concentrating
        8. irritability
        9. hyperactivity
        10. thin, brittle hair, pliable nails: plummer's nails
        11. diaphoresis
        12. insomnia
        13. reduced tolerance for stress